Provider Demographics
NPI:1639567498
Name:MAY, TIMOTHY LENARD JR
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:LENARD
Last Name:MAY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 SANTA ANITA AVE
Mailing Address - Street 2:SUITE #112B
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-1369
Mailing Address - Country:US
Mailing Address - Phone:626-636-2370
Mailing Address - Fax:626-453-3415
Practice Address - Street 1:3131 SANTA ANITA AVE
Practice Address - Street 2:SUITE #112B
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1369
Practice Address - Country:US
Practice Address - Phone:626-636-2370
Practice Address - Fax:626-453-3415
Is Sole Proprietor?:No
Enumeration Date:2015-01-02
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1213510915101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR1213510915OtherCCAPP